Lumbar Herniated Disc: Should I Have Surgery

Guides you through the decision to have surgery for a herniated disc in the low back. Describes the types of surgery available, as well as nonsurgical treatment. Lists the benefits and risks of both types of treatment. Includes interactive tool to help you make your decision.

Lumbar Herniated Disc: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Your options

This decision guide is for you if your herniated disc is
in your low back. It does not cover information about herniated discs in the neck area of the
spine (cervical disc herniation).

Key points to remember

Most people get better after a few months of
nonsurgical treatment, such as rest, medicines, injections, and
rehabilitation.

Surgery may be a good choice if you have
sciatica—severe pain, numbness, or weakness in your
buttock and leg—that has not improved with nonsurgical
treatment.

If you have medium to very bad pain that does not seem to be getting better over a few months of time, you will probably
feel better sooner if you have surgery. But over time your ability
to do your daily activities will probably be about the same whether you have
surgery or not.

If a doctor recommends
that you have surgery, it's a good idea to get a second opinion. You need to
get as much information as possible before you make this decision.

Surgery for a herniated disc doesn't usually cause problems. But there is a
slight risk of damaging nerves or the spine during surgery. Other possible
problems include problems from the
anesthesia and from infection that causes more damage.

Your doctor may recommend several weeks of
physical therapy and home exercises after surgery.

The bones that form the
spine—your vertebrae—are cushioned by small, spongy discs. When these discs are
healthy, they act as shock absorbers for the spine and keep the spine flexible.
But when a disc is damaged, it may bulge or break open. This is called a
herniated disc. It may also be called a slipped or
ruptured disc.

A herniated disc doesn't always cause symptoms. But
when it presses on nerve roots, it can cause pain, numbness, and weakness in
the area of the body where the nerve travels.

If the herniated
disc is in the lower back (lumbar spine), it can cause pain and numbness in the buttock and
down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the
most common symptom of a herniated disc in the low back.

If
you are getting better after at least 4 weeks of nonsurgical treatment, that's a good
sign that your body will continue to heal without surgery. Often the body
reabsorbs the material from the disc, which helps the pain go away. This
process is called
resorption.

Surgery for a lumbar (low back) herniated disc works well for many people but not for everyone. For some people, it can get rid of all or most of their symptoms.

A SPORT study found that people were more likely to feel better if they had surgery or other treatment before they had more than 6 months of symptoms.2

Some people decide to have surgery because they need to
go back to work or to their other activities as soon as possible. If your job
doesn't require you to be very active, you can probably go back to work 2 to 4
weeks after surgery. If your job is physically demanding, you'll need to wait 8 to 12
weeks.

The numbers in this section are for discectomy (standard discectomy and microdiscectomy), the most common surgery for herniated disc.

Recovery rates with back treatments*

Recovery

With surgery

With nonsurgical treatment

Symptom-free or almost symptom-free within 3 months

50 to 60 out of 100

20 to 30 out of 100

Symptom-free or almost symptom-free within 1 year

90 to 95 out of 100

80 to 95 out of 100

Need for surgery within 4 years

10 out of 100

10 out of 100

Examples of serious risks with back surgery*

Serious risks

With standard discectomy

With microdiscectomy

Permanent nerve damage

10 to 20 out of 1,000

1 to 3 out of 1,000

Death

1 to 2 out of 1,000

1 out of 1,000

*Based on the best available evidence (evidence quality: borderline to inconclusive)

Benefits

There is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. The quality of the evidence is borderline to inconclusive.

Take a group of 100 people who have sciatica caused by a herniated disc. The chances of having no symptoms or almost no symptoms 3 months later may be a little higher with surgery than with nonsurgical treatment:

With surgery, 50 to 60 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 40 to 50 may still have symptoms.

With nonsurgical treatment, 20 to 30 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 70 to 80 may still have symptoms.

After a year, the gap in recovery between those who used surgery and those who used nonsurgical treatment is much smaller.

At 1 year after surgery, 90 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 10 may still have symptoms.

After 1 year of nonsurgical treatment, 80 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 20 may still have some symptoms.

When it comes to the need for surgery within the next 4 years, there is no difference.

If they all have back surgery, 10 out of 100 people may need surgery again within 4 years.

If they all use nonsurgical treatment, 10 out of 100 people may need surgery within 4 years.

Risks

The evidence suggests that, like most surgeries, back surgery may have some risks. The risks may be higher for standard discectomy than for microdiscectomy, which uses a smaller incision and causes less tissue damage. The quality of the evidence about risks is borderline to inconclusive.

Take a group of 1,000 people who have back surgery. The more serious risks include:

Permanent nerve damage. With standard discectomy, 10 to 20 people out 1,000 may have lasting nerve damage, which means that 980 to 990 out of 1,000 may not. With microdiscectomy, the risk of nerve damage is lower: 1 to 3 people out of 1,000.

Death. With standard discectomy, 1 to 2 people out of 1,000 may die because of the surgery, which means that 998 to 999 may not die. With microdiscectomy, 1 person out of 1,000 may die because of the surgery.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.3, 4, 5, 6, 7, 8, 9, 10 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Personal stories about herniated disc surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I injured
my back working in the garden a few weeks ago. Based on the symptoms I'm
having, my doctor says it's pretty likely that I have a herniated disc. From
what I understand, the pain and leg symptoms will probably go away over time,
but I can't wait that long. My doctor says that the surgery will probably help
me recover a lot faster, even though over the long term it might not make any
difference. The short term is what's important to me right now, and I can
accept the potential risks, so I'm going ahead with tests and moving forward
with the surgery.

Dean,
age 39

Surgery has always made me nervous, even
though I've never had a bad experience with it myself. I just prefer not to
have surgery if I have any other option available. The pain and other symptoms
from my herniated disc are getting better, even if it's happening slowly. My
doctor said that it is reasonable for me to just keep doing home treatment and
take better care of my back. She also says that I'm not risking any serious
problems by not having surgery.

Mai-Li, age 57

The pain
from my herniated disc is the worst pain I have ever felt. My leg feels like it
is on fire. I know that isn't true for everyone who has a herniated disc, but
it sure is in my case. I'm willing to try a week or so of conservative
treatment, but if there isn't a dramatic improvement, my doctor has agreed to
go ahead with plans for surgery.

Jane, age 46

I'm lucky,
because my company has allowed me to take a job in another department where I
don't have to lift and where I can move around if I need to during the day. If
I wasn't able to do that, or if the pain was really bad, I would definitely
have had surgery. But this way I can keep working while my back heals on its
own. The pain is definitely still there, but it's manageable. I expect that
over time I will be able to return to most of my normal work and recreational
activities.

Javier, age
43

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for a herniated disc

Reasons not to have surgery

I am comfortable with the idea of having back surgery.

I don't like the idea of surgery at all.

More important

Equally important

More important

I've tried exercises and medicines for a few months, and I don't think they have helped me.

I think the exercises I've been doing or the medicines I'm taking are starting to help.

More important

Equally important

More important

I am in a lot of pain. I don't see how I can stand it much longer.

My pain isn't bad enough that I need to have surgery right now.

More important

Equally important

More important

It's very important that I get my pain under control so that I can go back to work as soon as possible.

Time is not a problem for me. If I get better slowly using exercises and/or medicine, that's okay with me.

More important

Equally important

More important

I'm not worried about how much this operation will cost.

I don't have insurance and don't see how I can afford this operation.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery for herniated disc

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

If I have pain because of a herniated disc, I probably need surgery.

TrueSorry, but that's wrong. Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.

FalseYou're right. Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.

I'm not sureIt may help to go back and read "Key points to remember." Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.

2.

Surgery might help me, because I have really bad pain from sciatica.

TrueThat's true. If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.

FalseActually, it's true. If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.

I'm not sureIt may help to go back and read "Why might your doctor recommend herniated disc surgery?" If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.

3.

Years from now I will probably feel just as good without surgery as I would if I have surgery.

TrueThat's right. Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.

FalseSorry, you're wrong. Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.

I'm not sureIt may help to go back and read "How well does herniated disc surgery work?" Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.

Watters WC, et al. (2009). An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine Journal, 9(3): 240–257.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Lumbar Herniated Disc: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for your herniated
disc.

Don't have surgery.

This decision guide is for you if your herniated disc is
in your low back. It does not cover information about herniated discs in the neck area of the
spine (cervical disc herniation).

Key points to remember

Most people get better after a few months of
nonsurgical treatment, such as rest, medicines, injections, and
rehabilitation.

Surgery may be a good choice if you have
sciatica—severe pain, numbness, or weakness in your
buttock and leg—that has not improved with nonsurgical
treatment.

If you have medium to very bad pain that does not seem to be getting better over a few months of time, you will probably
feel better sooner if you have surgery. But over time your ability
to do your daily activities will probably be about the same whether you have
surgery or not.

If a doctor recommends
that you have surgery, it's a good idea to get a second opinion. You need to
get as much information as possible before you make this decision.

Surgery for a herniated disc doesn't usually cause problems. But there is a
slight risk of damaging nerves or the spine during surgery. Other possible
problems include problems from the
anesthesia and from infection that causes more damage.

Your doctor may recommend several weeks of
physical therapy and home exercises after surgery.

FAQs

What is a herniated disc?

The bones that form the
spine—your vertebrae—are cushioned by small, spongy discs. When these discs are
healthy, they act as shock absorbers for the spine and keep the spine flexible.
But when a disc is damaged, it may bulge or break open. This is called a
herniated disc. It may also be called a slipped or
ruptured disc.

A herniated disc doesn't always cause symptoms. But
when it presses on nerve roots, it can cause pain, numbness, and weakness in
the area of the body where the nerve travels.

If the herniated
disc is in the lower back (lumbar spine), it can cause pain and numbness in the buttock and
down the leg. This is called sciatica (say "sy-AT-ih-kuh"). Sciatica is the
most common symptom of a herniated disc in the low back.

Usually a
herniated disc will heal on its own over time.

What kinds of surgery are done for a herniated disc?

The most common surgeries are:

Discectomy

It removes material that is pressing
on a nerve root or the spinal cord.

It is the surgery that works
best for people who still have very bad pain (sciatica) after
trying other treatments.

Often it can be done as
microdiscectomy, which uses a smaller incision and causes less damage to
surrounding tissue.

Percutaneous discectomy

It also removes material pressing on
a nerve, but it is done by inserting a special tool through a very small
incision.

It doesn't work quite as well as a regular
discectomy.1

Laminotomy and laminectomy

They relieve pressure caused by
age-related changes in the spine.

Laminotomy removes some of the
lamina, the thin part of the vertebrae that forms a protective arch over the
spinal cord.

Laminectomy removes most of or all of the lamina. It
also may remove thickened tissue that is narrowing the
spinal canal.

They may be done at the same time as a
discectomy, or separately.

Your doctor may recommend a rehabilitation program after
surgery, which can include
physical therapy and home exercises.

When is nonsurgical treatment used for a herniated disc?

Most herniated discs heal after a few months of nonsurgical treatment.
This treatment can include:

If
you are getting better after at least 4 weeks of nonsurgical treatment, that's a good
sign that your body will continue to heal without surgery. Often the body
reabsorbs the material from the disc, which helps the pain go away. This
process is called
resorption.

How well does herniated disc surgery work?

Surgery for a lumbar (low back) herniated disc works well for many people but not for everyone. For some people, it can get rid of all or most of their symptoms.

A SPORT study found that people were more likely to feel better if they had surgery or other treatment before they had more than 6 months of symptoms.2

Some people decide to have surgery because they need to
go back to work or to their other activities as soon as possible. If your job
doesn't require you to be very active, you can probably go back to work 2 to 4
weeks after surgery. If your job is physically demanding, you'll need to wait 8 to 12
weeks.

What are the risks of surgery?

Most people have no
problems with back surgery for herniated discs. But
as for most surgeries, there are some risks:

There is a slight risk of damaging nerves or
the spine during surgery.

Some people form a lot of scar tissue in
the area of the surgery. That tissue can press against nerves and cause pain.

There is some risk of infection, which may cause more damage. An
infection may require antibiotics and another surgery.

Serious
side effects of anesthesia are uncommon but can include trouble breathing,
heart attack, stroke, and even death.

What do numbers tell us about the benefits and risks of back surgery?

The numbers in this section are for discectomy (standard discectomy and microdiscectomy), the most common surgery for herniated disc.

Recovery rates with back treatments*

Recovery

With surgery

With nonsurgical treatment

Symptom-free or almost symptom-free within 3 months

50 to 60 out of 100

20 to 30 out of 100

Symptom-free or almost symptom-free within 1 year

90 to 95 out of 100

80 to 95 out of 100

Need for surgery within 4 years

10 out of 100

10 out of 100

Examples of serious risks with back surgery*

Serious risks

With standard discectomy

With microdiscectomy

Permanent nerve damage

10 to 20 out of 1,000

1 to 3 out of 1,000

Death

1 to 2 out of 1,000

1 out of 1,000

*Based on the best available evidence (evidence quality: borderline to inconclusive)

Benefits

There is no high-quality evidence showing that surgery is more helpful than nonsurgical treatment for a lumbar herniated disc. The quality of the evidence is borderline to inconclusive.

Take a group of 100 people who have sciatica caused by a herniated disc . The chances of having no symptoms or almost no symptoms 3 months later may be a little higher with surgery than with nonsurgical treatment:

With surgery, 50 to 60 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 40 to 50 may still have symptoms.

With nonsurgical treatment, 20 to 30 people out of 100 may have no symptoms or almost no symptoms after 3 months. This means that 70 to 80 may still have symptoms.

After a year, the gap in recovery between those who used surgery and those who used nonsurgical treatment is much smaller.

At 1 year after surgery, 90 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 10 may still have symptoms.

After 1 year of nonsurgical treatment, 80 to 95 people out of 100 may have no symptoms or almost no symptoms. This means that 5 to 20 may still have some symptoms.

When it comes to the need for surgery within the next 4 years, there is no difference.

If they all have back surgery, 10 out of 100 people may need surgery again within 4 years.

If they all use nonsurgical treatment, 10 out of 100 people may need surgery within 4 years.

Risks

The evidence suggests that, like most surgeries, back surgery may have some risks. The risks may be higher for standard discectomy than for microdiscectomy, which uses a smaller incision and causes less tissue damage. The quality of the evidence about risks is borderline to inconclusive.

Take a group of 1,000 people who have back surgery . The more serious risks include:

Permanent nerve damage. With standard discectomy, 10 to 20 people out 1,000 may have lasting nerve damage, which means that 980 to 990 out of 1,000 may not. With microdiscectomy, the risk of nerve damage is lower: 1 to 3 people out of 1,000.

Death. With standard discectomy, 1 to 2 people out of 1,000 may die because of the surgery, which means that 998 to 999 may not die. With microdiscectomy, 1 person out of 1,000 may die because of the surgery.

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.

The information shown here is based on the best available evidence.3, 4, 5, 6, 7, 8, 9, 10 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Why might your doctor recommend herniated disc surgery?

Your doctor might recommend surgery for your herniated disc if:

You have very bad leg pain, numbness, or
weakness (sciatica) that keeps you from being able to do your
daily activities.

Your leg symptoms do not get better with at least
4 weeks of nonsurgical treatment.

Your symptoms are getting
worse.

You need to get better quickly because of your
job.

Tests show that your herniated disc can be treated with
surgery.

You are able to follow a rehabilitation program for a
number of weeks after surgery.

2. Compare your options

Have herniated disc
surgery

Use nonsurgical
treatments

What is usually involved?

You are asleep or numb during the
surgery.

You will probably stay in the hospital overnight.

You try rest, physical
therapy, exercises, and medicines.

What are the benefits?

Surgery works well for many people
with medium to very bad pain.

Surgery offers faster pain relief
than other treatment.

With surgery, most people can go back to work
sooner.

You avoid having
surgery.

Nonsurgical treatments work for most
people.

Research shows that 10 years after treatment, people who
do not have surgery are just about as likely to be able to do their daily
activities as people who have surgery.

What are the risks and side effects?

Surgery does not always work, or it may
not work any better than other treatment.

There is a slight risk of damaging the spine or
nerves.

There is some risk of infection.

There are
risks with anesthesia.

Pain relief
comes more slowly than with surgery.

If you take medicine for pain, you may have side effects that you don't like.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

Personal stories about herniated disc surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I injured my back working in the garden a few weeks ago. Based on the symptoms I'm having, my doctor says it's pretty likely that I have a herniated disc. From what I understand, the pain and leg symptoms will probably go away over time, but I can't wait that long. My doctor says that the surgery will probably help me recover a lot faster, even though over the long term it might not make any difference. The short term is what's important to me right now, and I can accept the potential risks, so I'm going ahead with tests and moving forward with the surgery."

— Dean,
age 39

"Surgery has always made me nervous, even though I've never had a bad experience with it myself. I just prefer not to have surgery if I have any other option available. The pain and other symptoms from my herniated disc are getting better, even if it's happening slowly. My doctor said that it is reasonable for me to just keep doing home treatment and take better care of my back. She also says that I'm not risking any serious problems by not having surgery."

— Mai-Li, age 57

"The pain from my herniated disc is the worst pain I have ever felt. My leg feels like it is on fire. I know that isn't true for everyone who has a herniated disc, but it sure is in my case. I'm willing to try a week or so of conservative treatment, but if there isn't a dramatic improvement, my doctor has agreed to go ahead with plans for surgery."

— Jane, age 46

"I'm lucky, because my company has allowed me to take a job in another department where I don't have to lift and where I can move around if I need to during the day. If I wasn't able to do that, or if the pain was really bad, I would definitely have had surgery. But this way I can keep working while my back heals on its own. The pain is definitely still there, but it's manageable. I expect that over time I will be able to return to most of my normal work and recreational activities."

— Javier, age
43

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for a herniated disc

Reasons not to have surgery

I am comfortable with the idea of having back surgery.

I don't like the idea of surgery at all.

More important

Equally important

More important

I've tried exercises and medicines for a few months, and I don't think they have helped me.

I think the exercises I've been doing or the medicines I'm taking are starting to help.

More important

Equally important

More important

I am in a lot of pain. I don't see how I can stand it much longer.

My pain isn't bad enough that I need to have surgery right now.

More important

Equally important

More important

It's very important that I get my pain under control so that I can go back to work as soon as possible.

Time is not a problem for me. If I get better slowly using exercises and/or medicine, that's okay with me.

More important

Equally important

More important

I'm not worried about how much this operation will cost.

I don't have insurance and don't see how I can afford this operation.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery for herniated disc

NOT having surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
If I have pain because of a herniated disc, I probably need surgery.

True

False

I'm not sure

You're right. Most people don't need surgery. They get better after a few months of nonsurgical treatment, such as rest, medicines, injections, and rehabilitation.

2.
Surgery might help me, because I have really bad pain from sciatica.

True

False

I'm not sure

That's true. If you've tried nonsurgical treatment for sciatica and haven't gotten better, surgery may be a good choice for you.

3.
Years from now I will probably feel just as good without surgery as I would if I have surgery.

True

False

I'm not sure

That's right. Research shows that you may feel better sooner with surgery, but in the long run, nonsurgical treatment works about as well.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Yes

No

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.
Check what you need to do before you make this decision.

I'm ready to take action.

I want to discuss the options with others.

I want to learn more about my options.

3.
Use the following space to list questions, concerns, and next steps.

Watters WC, et al. (2009). An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine Journal, 9(3): 240–257.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Watters WC, et al. (2009). An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine Journal, 9(3): 240–257.

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